Medical Coder - Risk Adjustment Specialist

Join Senior Comm Unity Care as a Medical Coder - Risk Adjustment Specialist and partner directly with physicians and Medical Directors to improve documentation, support CMS reporting, and strengthen value-based care for older adults in the PACE program.

Medical Coder - Risk Adjustment Specialist
- Remote

Schedule: M-F 8:00 AM-5:00 PM

Salary: $58,000-$66,000 (Based on Experience)

• Collaboration for Risk Adjustment Integrity:
  Works closely with Medical Directors and PACE providers to uphold the integrity and accuracy of the risk adjustment reporting process. Engages in continuous dialogue with healthcare professionals to ensure that coding accurately reflects participant acuity.
• Medication Documentation Review and Diagnostic Coding:
  Reviews and interprets provider documentation to extract critical information. Assigns ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures from documented information in the medical record. Assures the final diagnoses and procedures are valid and complete. Communicates and resolves coding issues (lacking documentation, provider queries, etc.).
• Liaison Role:
  Acts as a key intermediary between PACE providers and contracted coding services. Ensures timely and effective response to coding-related inquiries and issues.
• Coding Compliance and Data Analysis:
  Facilitates the audit review process, collaborating with providers to resolve individual and systemic coding issues. Leads efforts to enhance coding accuracy and compliance through regular, targeted audits. Performs data analysis to uncover and seize missed coding opportunities.
• Report Review and Response Process:
  Works with clinical leadership to devise and implement procedures for generating and distributing participant-specific reports. Ensures these reports are reviewed by the provider during subsequent participant clinic visits, maintaining a system for tracking and ensuring accountability.
• Encounter Reporting Support:
  Applies coding expertise to support the accuracy of the encounter reporting process in applicable programs. Acts as a resource for program leadership in determining the appropriateness of coding used for encounters.
• Systems and Process Improvement:
  Assists in the continuous improvement of systems and processes to better align with the organization’s strategic goals. Contributes to the development of initiatives that enhance the efficiency and accuracy of coding practices.
• Remote Work and Accountability:
  Work independently in remote setting, demonstrating high level of responsibility and accountability. Collaborate with cross-functional teams as needed.
• Establishes and maintains a productive working relationship:
  Maintains the stability and reputation of SCC by ensuring all activities and operations are performed in compliance with local, state, and federal laws, regulations and contractual requirements and adheres to organizational policies. Supports program cultural standards through modeling, coaching, and accountability. Protects privacy and maintains confidentiality of all company procedures, results and information about employees, participants and families. Participates in continuing education classes and any required staff and training meetings.
  
  Maintains professional affiliations and any required certifications.

• Education:
  
  Associate’s degree in Health Information Management or related field.
• Certification:
  Current certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Experience:
  
  Minimum of five (5) years of experience working directly with diagnostic and procedural coding required. Strong preference for substantial experience with Hierarchical Condition Categories (HCCs) and risk adjustment methodologies.

• Ability to effectively communicate orally and in writing in English.
• Strong technical skills with proficiency in data management.
• Strong knowledge of medical terminology, anatomy and physiology, and disease processes.
• Familiarity with healthcare software including EHR systems, coding software, and data analysis tools.
• Understanding of regulatory requirements including HIPAA, CMS guidelines, AHIMA code of ethics, and other regulations affecting coding and billing.
• Proficient ability with Excel including ability to extract meaningful information from large datasets.
• Analytical skills and ability to interpret medical records and extract pertinent information for accurate coding.
• Strong problem-solving and critical thinking skills.
• Strong attention to detail.
• Effective communication skills for presenting information.
• Creative, detail-oriented, and organized.
• Must have integrity, practice discretion and practice objective problem solving.
• Skilled in establishing and maintaining effective working relationships and working collaboratively with a multidisciplinary team.

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